The air grew particularly suffocating between September and October 2025, when local authorities reported 122 cases of intoxication and asphyxiation caused by toxic fumes. Gas leaks from GCT’s facilities are widely blamed. 

On 15 October, the civil movement Stop Pollution mobilized 40,000 residents for a mass demonstration, followed by a general strike called by the national trade union UGTT, which drew more than 130,000 participants. The city of Gabès has around 150,000 citizens. 

The last protest took place on 17 December 2025, the anniversary of the 2011 Tunisian Revolution.

The Little Tunisian Chernobyl

Phosphate, one of Tunisia’s key natural resources, is largely destined for export. In 2023, Tunisia ranked as the world’s tenth-largest exporter of phosphate fertilizers, earning 61.7 million US dollars. The main destinations were Bangladesh, Brazil, France, Italy and the United Kingdom.

Phosphate fertilizers are widely used in intensive agriculture to boost crop yields. The practice can lead to the accumulation of toxic heavy metals such as cadmium in both soil and crops. And if these are the risks downstream, the dangers upstream are far greater. The combination of extractivism and export-oriented production has compromised Gabès as a whole, to the point that it is now dubbed the “Little Tunisian Chernobyl.” 

Today, the gulf the city overlooks is polluted by phosphogypsum, an industrial by-product of phosphoric acid production. It is generated by treating phosphate rock—extracted from the Gafsa mines, 150 kilometers from Gabès—with sulfuric acid. Studies have shown that phosphogypsum contains high levels of uranium and radium, both radioactive elements.

Dying Meadows of the Sea

According to a 2021 study by Oréade-Brèche on biodiversity loss in Tunisia, every ton of phosphoric acid produced generates between four and five tons of phosphogypsum. Over the past 25 years, an estimated 70 million tons of phosphogypsum have been discharged into the Gulf of Gabès, contaminating sediments across roughly 60 square kilometers. 

Marine flora and fauna have borne the brunt of this pollution. Combined with rising sea temperatures driven by climate change, the contamination is causing the progressive disappearance of Posidonia oceanica, a Mediterranean seagrass that serves as a vital refuge for fish species, crustaceans, and mollusks. 

Posidonia also plays a crucial ecological role: it helps prevent coastal erosion and oxygenates seawater by absorbing CO₂. These seagrass meadows account for 10% of the ocean’s carbon storage capacity—twice as much per square kilometer as terrestrial forests. 

At the beginning of the 20th century, the Gulf of Gabès hosted the largest Posidonia meadows in the Mediterranean; today, phosphogypsum discharges are estimated to have destroyed around 90% of them. In their place, the invasive alien algae Caulerpa has taken hold.

The disappearance of Posidonia has dealt a severe economic blow to small-scale fisheries, causing losses that exceed the added value of Gabès’ phosphate-processing industry.

Once known for its rich fisheries, the sea off Gabès is now grappling with a drastic decline in fish stocks. Pollution has coincided with industrial trawling by large fishing vessels, progressively stripping artisanal fishers of their livelihoods. 

Suffocating Protests

Moreover, as a 2018 European Commission study on the economic impact of industrial pollution in the region illustrates, there is a correlation between rising cases of chronic bronchitis and asthma in the neighborhoods of Ghannouch, Chott Essalem, and Gabès city, and the pollution generated by GCT’s activities.

Air pollution from sulfur dioxide, ammonia, fine particulate matter, and fluorides lies at the root of the region’s cases of intoxication and asphyxiation. According to the European Commission, concentrations of these substances near the GCT plant far exceed both Tunisian and international standards. 

Confronted with this reality, the people of Gabès began to raise their voices. Already in 2012, a group of residents founded Stop Pollution, a social movement demanding the dismantling of GCT’s polluting facilities. Since then, the group has organized protests, raised awareness, and informed the public on issues related to energy transition.

In 2017, the movement achieved its first major breakthrough: then–prime minister Youssef Chahed approved a plan to dismantle the six phosphate-processing units in Gabès and rehabilitate the sites in line with international standards. Yet the decision was never implemented. Instead, the government reversed course entirely.

Last March, the restricted Ministerial Council decided to raise phosphate production from under 3 million tons a year to 14 million by 2030, including expanded transport and processing capacity. The move comes amid a surge in global fertilizer prices. The plan also sets the stage for a pilot unit to produce green ammonia in Ghannouch. 

In 2024, Tunisia signed six memoranda of understanding (MoUs) with several European multinationals for the production of green hydrogen. The national green hydrogen strategy sets an annual production target of 8.3 million tons by 2050, with 6.3 million tons intended for export to Europe. This strategy has been supported since 2022 by the German Agency for International Cooperation (GiZ) through the project “Green Hydrogen for Sustainable Growth and a Low-Carbon Economy in Tunisia (H2Vert.TUN).” 

The exported hydrogen would be transported via the SoutH2 Corridor, which will connect Tunisia and Algeria to Italy, Austria, and Germany.

Environmental obstacles were swiftly sidestepped: phosphogypsum was removed from the list of substances classified as hazardous to human health.

Meanwhile, Gabès continues to suffer. On 17 October last year, Gabès’ citizens filed a petition before the Gabès First Instance Tribunal requesting the immediate closure of GCT’s polluting units. The preliminary hearing was scheduled for 23 October; however, the examination of the case has been postponed several times. 

The next hearing is expected to take place on 12 February. Assisted by the regional section of the Bar Association and the Regional Council of the Medical Association — which will present health data collected in Gabès — Stop Pollution and the people of Gabès have launched an unprecedented legal action. As Amir Ammar, a PhD student in Law, states in Village de la Justice, this is the first class action that “directly targets a major industrial actor (and a public one at that) in order to stop environmental harm in Tunisia.”

To understand what the people of Gabès endure each day—and how upcoming industrial projects could worsen the environmental crisis—we spoke with Aziz Chebbi, researcher in international law and political science, and activist with Stop Pollution.

Nadia Addezio: How have residents’ health and the state of the environment in Gabès changed over the years? 

Aziz Chebbi: Since 1972, since the Groupe Chimique Tunisien began operating in the Gabès region, the area has suffered environmental damage across three fronts: air, land and sea. First, marine pollution: phosphogypsum waste is discharged daily into the waters of Chott Essalem in Gabès. These discharges have had a direct impact on the livelihoods of local fishers, many of whom have lost their jobs and been forced to abandon a profession passed down through generations.

Then there is soil pollution: heavy metals in the land around Gabès have severely compromised local agriculture. The region’s emblematic oases have been deteriorating steadily, and farming activities have been deeply affected for more than 50 years. Finally, air pollution has taken a dramatic toll on residents’ health. The area records very high cancer rates, as well as frequent fainting episodes among students, especially in September and October.

Pollution across these three fronts devastates daily life in Gabès, undermining people’s health, their economy, and their dignity. Every day, residents simply aspire to breathe clean air and live in an environment that respects human dignity, as guaranteed by the principles of the Tunisian Constitution.

Between 2012 and 2017, numerous grassroots mobilizations helped secure a government decree—issued on 29 June 2017—ordering the dismantling of the polluting plants in the Gabès region. However, the decree was never published in the Official Gazette by the then-President of the Republic Béji Caïd Essebsi. As a result, the authorities failed to acknowledge the scale of the harm caused by the GCT and neither acted on nor upheld that decision.

Unfortunately, from 2017 to today, no government has shown real political will to enact or advance this measure. No significant progress has been made, leaving residents in a constant state of waiting for a sincere political commitment to environmental justice in Gabès.

NA: How did you respond to the government’s decision to revive phosphate production and remove phosphogypsum from the list of hazardous substances? Do you have any direct dialogue with the government or with the GCT?

AC: For years, the government has failed to consult civil society organizations or citizens when drafting its decisions and administrative decrees. In March 2025, it adopted a measure stating that phosphogypsum would no longer be classified as a hazardous substance, paving the way for its “valorization” and for the creation of a pilot plant to produce green ammonia. Faced with this decision—which we consider extremely worrying—we organized several demonstrations.

Because the announcement came during Ramadan, we held a protest in Tunis in April 2025, followed by a large march in the Gabès region in May. At the same time, we published statements and held several press conferences to spark public debate about these government decisions. We also carried out awareness campaigns among Gabès residents to explain the environmental and health risks associated with these policies. 

These efforts culminated in September 2025, a period marked by numerous fainting incidents among students and by heightened toxic emissions from the GCT’s facilities. More and more citizens are adopting our narrative and mobilizing with growing determination toward our shared goal: the complete dismantling of these polluting plants.

NA: The paradox is that the GCT provides jobs. What do GCT workers think? 

AC: In reality, GCT workers are themselves residents of the Gabès region, with children who attend local schools. During recent demonstrations, we noticed a significant development: a growing number of workers—through their unions or individually—support our actions and take part in mobilizations on the ground. Recently, there have even been fainting incidents among workers inside the GCT itself.

NA: As you mentioned, there is now talk of a possible green transition for the industrial hub. Among the proposed projects is the production of green ammonia, part of Tunisia’s national energy strategy and its plans for green hydrogen. How is this project perceived in Gabès? 

AC: There are two essential points on this issue. The first concerns our refusal, as a social movement, of any new installation within the Groupe Chimique Tunisien complex. Establishing a new entity on that site would mean completely disregarding the citizens’ core demand: the environmental rehabilitation of the Gabès region.

The second point concerns the national green hydrogen strategy, which includes the production of green ammonia. We view this strategy as a neo-colonial dynamic, imposed by GIZ, and designed exclusively to meet German energy needs. 

Berlin is seeking to externalize its energy production to countries in the Global South—Namibia, Tunisia, Morocco, Egypt—turning them into suppliers of green energy. Producing green ammonia requires green hydrogen, which demands vast amounts of water and renewable energy. It is an extremely energy-intensive process. Tunisia does possess abundant natural resources such as sun and wind, but these resources should meet our own energy needs, not feed German power grids.

Moreover, Tunisia currently has no real domestic demand for green hydrogen within its industrial sector. If, in the future, industries arise that require it, the decision should be made collectively, through a participatory process involving citizens, experts, and civil society, based on a transparent assessment of benefits and risks. It should not be dictated by a strategy conceived in ministerial offices in partnership with a German cooperation agency that has no stake in Tunisia’s needs or priorities.

This project is therefore not an opportunity but a real threat: it risks worsening the environmental crisis in Gabès, particularly through the seawater desalination projects required for green hydrogen production. The discharge of brine into the sea will have severe consequences for marine biodiversity and for numerous local species already weakened by decades of industrial pollution.

NA: What will be the collective’s next steps?

AC: So far, the public authorities have shown no reaction. In the face of this governmental silence, we will continue our mobilizations and maintain our demand for the dismantling of the polluting facilities in the Gabès region. Residents fully support our actions and share our demands. Every time we call for mobilization, the population responds. We will go all the way to obtain a clear political decision and a concrete response from the authorities, one that meets the legitimate expectations of the region’s inhabitants.

Gabès could be a paradise on earth: the oasis system that surrounds the sea, the mountains and the desert is an exceptional national heritage that must be preserved and valued. Alternatives do exist. Agricultural development, ecological and community-based tourism, and activities linked to the sea can offer new, sustainable job opportunities.

The GCT, by contrast, brings nothing but harm and threats to the environment and health of the Gabès region. The current jobs tied to this industry can be replaced by local, sustainable and non-colonial economic alternatives.

The post Gabès Is Suffocating: Breathing Under Phosphate, Protest, and Green Colonialism appeared first on Untold.

I try not to imagine my nephews or nieces because thinking of them under a barrage of bombs could break me even more. That day I received a WhatsApp message from my niece. It said, “Is my grandmother fine?” She sent it and then seemed to lose her internet connection.  For the past two years, I have been doing everything I can to provide for my family in Gaza, hoping to give them a small sense of safety—like a bird sheltering its young in a nest.

I immediately knew something was serious. Why would my niece contact me and not my brother, who lives with my mother? I called her on her mobile and she said, ‘they say that my grandmother is very ill, and my mother has run to her.’ That day in Gaza, dozens were killed by Israeli drones and attacks. When I called my brother, he was crying. I knew that my mother died. I said to him, “God has chosen her. Be strong”. I hung up the phone and burst into cries. 

I did not know that my mother was killed by Israeli drones. I imagined my mother had died naturally, having suffered from a lack of medication and malnutrition. She had lost a lot of weight. I continued running towards home, but tears were streaming down my face.  My mother was gone. They had killed her. 

Countless Loss

This was not the first time I had experienced loss during the genocide in Gaza. The year before my mother was killed, on December 4, 2023, I opened my Facebook account to see a picture of my niece and mourning messages for her. She was planning to apply for her PhD. She was killed in Deir Al Balah while displaced from her home. I felt devastated at that moment. 

In summer 2024, I opened my eyes to dozens of messages and missed calls. I thought of the worst. But one message got my attention, “We are fine. Mother is fine”. It was from my brother. It happened that when I closed my eyes around 2am, Israel attacked a place where dozens of my family members live, killing 17 among them, and later, my aunt joined them. 

I returned to news channels, and social media reports, it only said my family name. If I was awake, it would have caused me tremendous panic, considering the inability to reach my brother. Reflecting on this, and after twenty months, it seemed that death was just a matter of time, and my family was waiting as if they were standing on the gates of a human slaughterhouse, run by Israel.   

How? Why? I lost more than 70 other members of my family in the recent twenty months, just in August and September 2025, I mourned one or two relatives every week. In between the first draft and the final one of this article, Israel killed two relatives. But this was not the first time I had lost loved ones to the Israeli occupation. I had experience of this at ages seven, 12, and 16.  

Grieving Home

In December 2023, I learned to grieve not just people but my home and my physical memories. I was sitting at my desk in Stockholm at work when the Israeli propaganda machine shared videos of their attacks on Gaza City, claiming they were annihilating Hamas. 

I had been advised to avoid constantly looking at my phone during the first few months. I still did – as I watched the video, my brain stopped working when I saw the Israeli army’s propaganda. There was an attack on the home where my family lived and where I grew up in the Shejaiya area. This place was filled with memories of my childhood. I ran in that street bare feet, I chased goats there, and there I sat with my father and walked along that street for years. 

In the video, soldiers were running, shooting, and attacking our home. It was a shocking moment. I continued working that day, but I was devastated and lost concentration. Since the start of the Gaza genocide, I occasionally see friends being mourned and family members being announced dead. Every time, it feels more devastating, and it only makes me fear loss more. 

Loss and trauma at the hands of Israel is part of being a Gazan. From the moment I took my first steps until my school years and then years later, I was a small, impressionable child caught in a society overwhelmed by soldiers, guns, pervasive fear, violence, and confusion. This reality was ingrained in me, as integral as my own skin, tightly woven into the very fabric of my existence and not easily shed even once I left Gaza and moved to another country. 

Each day as a child, the sight of military jeeps in Gaza became intertwined with my childhood fantasies. They were so entrenched in our lives that we began to name these intruding vehicles of occupation after animals, drawing inspiration from their strange shapes and distinctive sounds. There was for example the  cockroach for its noisy sound and its shape.

From a young age, I was familiar with not just violence, but death. I encountered it more closely than most. In 2000, an Israeli sniper shot a rubber bullet toward my head, and fortunately, it narrowly missed my right eye. If it had gone half a centimetre lower, I might have been dead or at least disabled, losing vision in one eye. 

My life could have been extremely different. Our relative was assassinated during the First Intifada, and I cried for him, for the first time mourning someone’s death. My classmates were killed in the Second Intifada. I walked behind and carried their coffins. Since I left Gaza in 2007, I stopped counting how many of my classmates and childhood friends had been killed. I counted more than fifteen, and I stopped. Each name I counted felt like a hammer dropping on my chest, pounding it. 

Scars of Trauma

Death suddenly became my friend. I thought I knew death, but not until the Gaza genocide started. I started to say that my life after 2007 is just a surplus, and an extra time was given to me. 

My life has helped me to understand the meaning of loss amid a genocide, and what it means to grieve. Grief is a response to a specific event, such as the loss of a beloved person, losing a place, a memory, turning one’s thoughts to that person, and reflecting on their life, or thinking about memories and lost places that hold psychological and mental connections. Part of grief is learning to adjust to the loss. 

For me, to adjust to my grief, it means that an emptiness arises, and this affects plans, activities, and even future vision. It can be a moment of refiguring one’s life and purpose. When we lose someone, we love and care about, we can lose the anchor that holds the family together. This is particularly the case when losing a father or mother. When we relate to a loved one, we create a bond, a memory, and an identity that surrounds them. 

I formed an identity around my father as the carer and provider of our family, and that’s why when he died, I had to take over his position sometimes to check on and care about my siblings, before and after the genocide. 

As the time passed, I thought about my niece, mother, aunt, relatives, friends, the city where I was born and grew up, and the memories we shared. I realised I couldn’t cry anymore. It felt like my entire world and my siblings were on the verge of dying, and my heart was frozen and crushed, yet I couldn’t find the power or time to weep. I just had to keep going with my life, because my first thoughts are that others are relying on me. 

Even before the genocide, I had tried to be strong, knowing that as someone who had lost so much, I couldn’t afford to be weak or surrender. But this time was different – one memory after another had been destroyed, and there were no tears to be found. My eyes were dry, and I’d never felt my tears so dry. 

When my mother passed away, I felt completely isolated. She was the one who would always check in on me, or so I thought. I wondered why I didn’t cry more for her, why I could hear my heart crying and my soul being crushed but I couldn’t seem to break down. Some might argue that it was because I grew up in a society that discouraged men from crying and encouraged women to weep. But I saw my father crying for his mother, and I saw many men, since I was a child, crying for their siblings and loved ones who were killed by Israel, just as I cried and wept alongside them as a child. Yet now, for my mother I couldn’t cry. 

Everyone I’ve lost carried the scars of the trauma Israel has inflicted on them and on all Gazans. My father died in 2019 and I was not able to bid him farewell after 13 years in exile. My mother was murdered in the Gaza genocide. They were in their seventies, but their absence was sudden and unexpected. Our separation was inhumane and painful.  

Beyond Stages

As Palestinians, we’ve known from a young age that life and death are not in our hands, but in the hands of the Israeli occupation. They can kill us, starve us, torture us, or let us live in inhumane conditions. We can do little to object. I remember my parents would say to us when we were in our forties, “There aren’t as many years left as many as we’ve already lived.” Or “When we’re gone, take care of your sisters.” The last words of my father when I left him in Gaza were “Make me proud, alive and dead.” Their words were tinged with the reality of living in Gaza where death is part of our life. 

Elisabeth Kubler-Ross’s book, Death and Dying, describes five stages of the grieving process: denial, anger, bargaining, depression, and acceptance. These stages are essentially a progression of people’s emotions and may apply to certain cultures or typical death situations. 

However, in my experience, and that of the Palestinian people, these stages merge and persist, overwhelming us every hour and minute. Even if they aren’t immediately apparent, they linger in the back of our minds and consciousness. For us, grief is a constant process of piecing together the shattered remnants of our lives and coping with the residual trauma. 

The grief we experience is compounded by multiple losses and griefs over time. It’s like being repeatedly cut by a shard of glass that shatters on our faces each morning, reminding us of the injustices, losses, and ongoing pain, as well as the unpredictability of what the next wave of grief might bring. Usually, grief in Western scholarly work focuses on specific processes and stages, which reflects how Western culture views grief and adapts the concept of the five stages. For Palestinians, it is more complex, and for Gazans, it is even more so, both individually and collectively. 

Other studies concerning loss suggest that depression tends to lessen over time, but for me, anxiety, depression, feelings of loss and unsafety remain the same or even increase over time. This is because the conditions are still present and getting worse. The Israeli killing and destruction machine, a genocidal state, is like a ghoul waiting to harm more and more. 

Dry Tears

When it comes to sleep, I barely slept more than five hours a day in the last twenty three months of the genocide. For some weeks and for many days, only three hours. However, when I began to sleep more, particularly after my mother was killed, as she was the one I felt I needed presence from, it reflected in my being, and I saw my mother in my dreams. I started seeing other dead people. I saw my father more often and many others whom the Israelis murdered. I would also dream of the war, of my childhood home back in Gaza. I would wake up and run to the internet to seek interpretations of my dreams. Usually, they are helpful, but sometimes they make me overthink and start calling my siblings in Gaza.

Such a dream would leave me reeling for two or three days, until a new one took over and I began to think about new challenges and what’s to come. These dreams make me take on even more responsibility – a social and religious one, where I feel like I must be a fitting legacy for my beloved, lost ones. And that grief would be on a different level altogether. 

For me, death has become a barrier to life, not the end of our connection. But this loss isn’t a normal one; it was caused by a coloniser and oppressor, which makes it even harder to accept that someone has shattered part of me.  

For Palestinians in general, and Gazans in particular, the uncertainty of life makes grief impossible and complicated. You need space and time to grieve. You need peace. In a genocide, just the thought of surviving day to day, and who might be lost is unbearable and takes up all your mental energy. 

In a genocide, strikes are sudden, as perpetrators hunt people down, killing them with joy. When I try to grieve, the uncertainty of keeping the rest of my family safe haunts me, and I put my grief on hold, keeping the shattered pieces inside, leaving scars that continue to wound. However, this uncertainty takes a significant toll on one’s mental state. Research shows that people who struggle with uncertainty are more likely to develop depression, anxiety, and suicidal thoughts. 

This explains why, with every attack on Gaza, I start tracking the attack and check in with my siblings who are nearby. I often glance at my phone, checking in every so often. Recent research showed that the Palestinians in Gaza who suffer from genocide suffer from fear of death, depression, and loss of life satisfaction. This illustrates why, during a meeting and a motivational moment at work when a colleague asked everyone who felt proud to stand, I did not feel proud. I wasn’t satisfied with my achievements, even after signing a contract for my childhood memoir. 

Art dealers started to offer to buy my work—though I never saw myself as an artist—and I felt I was doing something for the Palestinians, yet none of this made me feel proud. Nothing makes sense when I’ve lost my mother, home, and my loved ones are being destroyed. This ongoing trauma and suffering are relentless. 

Gaza Annihilation Traumatic Syndrome

The trauma experienced by Gazans should warrant a new term, ‘Gaza Annihilation Traumatic Syndrome’ (GATS), which would signify the destruction of individuals, memory, identity, and potentially their future. Persistent and complex grief can lead to mental disorders related to traumatic events. In 2018, the World Health Organization included a grief-specific mental disorder, known as prolonged grief disorder (6B42). This condition is characterized by intense longing, persistent preoccupation, and significant emotional distress—such as anxiety, denial, anger, feelings of having lost a part of oneself—and substantial impairment in daily functioning over time. 

Unfortunately, mental health concerns and this disorder may become widespread in Gaza, requiring targeted attention. Including 6B42 in GATS could add complexity and highlight the need for effective interventions to address mental health impacts in affected populations.

After my mother’s death, challenges began to make sense. I was strong enough and had more strength to stay focused, but then things changed. Staying focused while working without watching the news became difficult. My psychological therapy was ineffective, and I started waking up around midnight to do things I never thought I would do.  For example, I would wake up at three in the morning to paint or make coffee. I started to forget things, and my mind began to feel foggy inside. 

Sleeping pills helped, but I felt tired most of the day. Running helped me to regain some sanity, but I occasionally felt sleepy, and my face lost its usual smile. I felt as though I had suddenly aged by 20 years. My perception of faces and the world around me changed. 

My mother’s death occurred during the Gaza starvation, which made me look at food differently. I decided to eat only one meal a day as a gesture of solidarity and grief for my siblings in Gaza. I realised that I was unable to present a coherent face to the world, and my smile started to seem fake day after day. At times, I wanted to cry, but my eyes held back tears, while my heart continued to cry beneath my skin.  

As someone who started running as a coping mechanism for depression and PTSD long before the ongoing Gaza genocide began, running has become a dangerous habit. Once I start running, I lose track of time, and when I begin walking, I lose track of time. I end up in the same places repeatedly. Of course, it is a way to minimise anxiety, but the scariest part is when news becomes overwhelming, especially when I read that Israel wants to ethnically cleanse Gaza. 

I think of my father’s grave in Gaza, my mother before she was killed, and my siblings. It’s frightening to see how my city and loved ones can be erased, with no hope or help in sight. My name has been linked to Gaza; friends and colleagues in many places called me “the Gazan”. When I think of the city, my siblings, I feel like I am going crazy. I need to leave the office or set work aside and go wash my face or walk. The feeling of losing my mind thinking is indescribable.

According to Lisa Shulman, the brain acts as a filter, sensing the threshold of emotions and memories that we cannot handle. However, in a long process of genocide, daily killings, and constant fear and worry, the brain finds it difficult to function normally and work as a filter. Even if my brain may work generally, the trauma affects work performance. 

Humans cannot change that, according to Shulman, we are, as humans, at the mercy of the process by which the brain handles emotions and memories, with grief occupying a significant portion of the brain’s bandwidth. This is worse for Gazans as they experience complicated, prolonged  unending grief. 

Other studies have found that grief alters the brain size and its activities. A study found that individuals experiencing prolonged grief had a smaller left hippocampus, a brain region essential for memory formation. Researchers suggest that grief may indirectly reduce the size of this area due to increased stress. Changes in memory function have been observed following significant losses and during periods of heightened stress. Other research indicates that prolonged severe grief may permanently reduce an individual’s capacity to learn, use language, and manage thoughts. This is thought to occur because grief affects two areas of the brain: the amygdala, which determines significance and manages anxiety, and the paraventricular thalamic nucleus, which influences responses to long-term emotional memories.

I am terrified about the potential development of complicated, prolonged, severe grief, as I call it: GATS, both for myself and for members of the Gazan diaspora who have endured prolonged periods of mourning. Research indicates that individuals who have experienced the loss of loved ones due to violence are at greater risk for complicated grief. 

The symptoms overlap with depression, PTSD, and anxiety, and may also involve cognitive decline. Although individuals with complicated grief often appear to manage daily life, they typically alternate between intense mourning and fulfilling routine responsibilities. This has been my experience; I find myself compelled to continue with daily tasks while processing my grief. 

Moments of remembrance involving my parents sometimes occur unexpectedly during professional activities such as moderating sessions, writing emails, or attending meetings. This became more frequent following my mother’s killing, evolving from occasional recollections of my father to regular, sometimes hourly, experiences. Despite these challenges, I strive to manage feelings of despair and maintain resilience. I run, I smile, I paint, I write, and I cook. But behind all of this is a weight of mountains on my heart and shoulders.

While reading about grief, as a coping mechanism and experiencing it myself, I have found that grief is a complicated journey, and it can take a long time. According to a study, grief can last up to fifteen years if not forever. One of the symptoms that persists for a long time is lower satisfaction with life.  

One day, I may come to accept the fact of loss as shattered, sharp glass that hits me every day but that reminds me that I’m alive and breathing and how lucky I am to carry the legacy of those I’ve lost. 

For Palestinians, grief is one-of-a-kind, and nothing resembles it. It should be respected and acknowledged as such. 

The post A Chronicle of Loss and Unending Grief: Gaza’s Genocide and the Weight of Inherited Grief appeared first on Untold.

A crowd has gathered in front of the KNDS weapons factory in Anagni — though nobody calls it that. Locals refer to it as the “ex Winchester,” named after the rifles and guns that were produced there from 1965 -the year of opening- until 2001. 

The crowd is protesting against an industrial plan by the Italian government and local authorities to place a new weapons factory in an area contaminated for more than a century by chemical and military industries. The Sacco Valley, where Anagni is located, is forced to fight an intersectional struggle: against weapons, for the environment, for health rights, and even for peace in Palestine.

Over the past twenty years, Anagni has become a centre for military waste management, in an area that has grown increasingly economically depressed. 

A diverse crowd

The people gathered there come from many different backgrounds politically and socially: Local representatives of trade unions, the left-wing Communist Refoundation Party, and the parliamentary Five Star Movement.

Different generations are united in this fight, too. In front of the factory gates stand people who remember when the industrial district was still prosperous and profitable for entrepreneurs. Then there are those who began fighting for an alternative model of development between the 1990s and early 2000s — now in their fifties — and many in their thirties, a generation increasingly seeing emigration as their only viable option. The Sacco Valley has made them pay the price for decades of unsustainable development. Unlike their grandparents, they have never known real prosperity. Many of them are unemployed.

“A predatory investment”

The Winchester factory received generous European financing of 24 million euros. This funding is part of the ASAP (Act in Support of Ammunition Production), part of Rearm Europe, the European plan that has invested more than 800 billion euros in weapon supply and production. KNDS, a German-French joint venture in the defense sector, has owned the ex Winchester for four years, since the merger between Nexter and Krauss-Maffei Wegmann happened in 2021. It’s a joint-venture at 50-50% between Berlin and Paris: the Krauss-Maffei was established in 1863, and was one of the main producers of tanks and bombs during World War II. Nexter is a French group, fully owned by the French agency for State participations. They both want heavier governmental investment in European defense.

This investment, according to Alberto Valleriani – the president of the environmentalist collective “Safeguard of the Sacco valley”- is predatory: “These are highly-automated productions. KNDS is telling us ‘we will invest, to create workplaces’. They lie. By doing so, they aim to divide our society: citizens against citizens, citizens against workers and so on.”

What Anagni needs, according to Valleriani and other protesters, are heavy investments in public health and industrial reconverting. Dialogue is needed, too. “Dialogue with the management of the factory doesn’t exist. We cannot enter there. And even the local administration cannot talk to them”, adds Valleriani. I experienced the same thing: I wrote an email to Bruno Pirozzi, the director of the factory. He didn’t reply.

“There is something dystopian even in the work organisation in KNDS. The engineer and the workers are split in two groups, to avoid any contact and avoid strike. The same applies for the other factories around KNDS: the schedules are made to avoid any meeting in the aftermath of day work”, many people tell me. “This is how KNDS prevents strikes”. 

Emanuele Ricchetti, member of the collective Madeinterraneo APS -a group of activists born for the inclusion of the immigrants in Anagni-, explains to me that they are trying to engage in a dialogue with the workers inside the factory towards the trade unions’ representatives. “It’s vital for us to dialogue with people who spend 8 to 10 hours a day in the factory. Willing or not, we need a confrontation”.

Fear of explosions

In front of the gate there’s Lorenzo, too. He’s an activist, and he explains to me what are the fears of the protesters: “the risk of accidents during the transportation of the nitrogelatine and the ammunition is really high. And we have a highway just close to the factory: what if there was an explosion?”

This scenario is not concrete just outside the factory: in 2007, an incident inside the KNDS of the town of Colleferro, few kilometers away from Anagni, killed an employee and injured 13 others. “There were other incidents in the following years, but just the one happening in 2017 was covered by a press release. Most of them were hidden by the management”, Valleriani tells me. Antonio Caporilli, another activist, adds that they heard about two others in 2014 and 2024 by the workers of the factory, but no official statements were released by the enterprise.

But that’s not the only problem. “In case of an incident, we have a backup plan: we should go to the hospital in Anagni. Shamefully, it has been closed since 2012”, Lorenzo tells me. The emergency plan was elaborated in 2012, and there has been no updates since then. The other hospitals in the area (Colleferro and Frosinone) are heavily underfinanced. And so, an effective emergency plan seems difficult to elaborate, for the moment. 

Health issues

But weapon production is not the only problem the population is facing. “In my personal experience, it is hard to find a family with no siblings that developed tumors. We know what’s going on and it affects the collectivity, directly or not”, Francesca Fiorletta tells me. She studies medicine in Rome. “The most frequent illness is breast cancer. Then, many develop similar issues with their testicles, liver – or ovaries, according to epidemiologists”. The project SENTIERI, from the health institute in Italy, documented an increasing mortality caused by tumors to stomach, liver and lungs. 

The contamination in Anagni affects the blood, too. The monitoring project Indaco found severe blood pathologies for people aged 0-19 years. Here, the water consumption is limited, because of the severe pollution. But still, many people have their own well, because of a certain “rural wisdom”, which puts self-sufficiency as a key value.

By looking at the fields behind the factory, one cannot think that this is a highly polluted area, but the toxic particulate matter -a mixture of solid particles and liquid droplets found in the air- is a serious issue, too. “Someone who lives in Anagni has 67% more possibilities to develop heart issues, compared to the national average”, Francesca tells me. Same for asthma and Chronic Obstructive Pulmonary Disease (COPD).

“Many people in the area suffer from thyroid issues, 21.4% of the general population, according to the epidemiological monitoring program INDACO in 2022. They figured out that they had some pathology only in old age,” Francesca tells me. In fact, Anagni is one of the most contaminated areas within the SIN (National Interest Site): having more accurate and localized data would be crucial for preventing cancer here.

“2.4% of the population developed auto-immune illnesses, according to INDACO. The incidence increases especially for lupus, rheumatoid arthritis and intestinal inflammation”, adds Francesca. “I see this everyday: as a student and a future doctor, I always try to be updated about what’s going on here. I need to be ready, one day my turn to assist the community will come”. 

A century of death factories

The Sacco Valley, the area where Anagni is located, is deeply contaminated because of a long chain of bad decisions. The area, especially the neighbouring town of Colleferro, witnessed an intense industrial development between from 1912 until the 1980s. “My father worked as a labourer in the factories in this area”, Valleriani tells me. “It was a great means of social redemption, at that time”.

Fiorletta’s family experienced the consequences of this firsthand: “We are not originally from here: my great-grandparents arrived from Tuscany in the 1940s, to work at the factory”. That’s why all her neighbours haven’t an “Anagnine” surname: they are mostly of Southern Italian ancestors. 

Her great-grandfather started immediately to work in the weapon plants, her mother in the chemical industry. Their story is deeply melancholic: when her grand-mother was two, her great-grandfather died because of an incident at the ex-Polveriera, a factory producing gunpowder in Anagni. It was owned by the Bombrini-Parodi-Delfino, the first industry of weapon production, established in 1912. “He was cleaning the basin for the production of the explosive. They didn’t follow the security protocol, and my grandmother received a pension that wasn’t enough to survive”. It was 1943. The great-grandmother, too, lost a finger during her work. 

But the area of Colleferro and Anagni was a center of massive and complex industrial development, starting from the 1950s. Italy itself heavily invested in subventions to this district. That’s why the chemical almost entirely replaced the military industry.

But, since the end of the 1980s, the industry started to run slower. However, pharmaceutical, military and chemical industries continued to dump their industrial wastes in the river Sacco and to bury them. It was mostly lindane, an insecticide. “I remember, up to 2000, seeing some white foam in the river. Nobody really cared”, Valleriani tells me. In 2005, some analysis of the milk produced in that area found a massive concentration of ß-HCH (Beta hexachlorocyclohexane), a cancerous molecule.

Anagni became a Site of National Interest (SIN), an area where an environmental emergency is declared by the national government itself. What this meant first, was limitations on water consumption -water is one of the main means of contamination, both by skin contact and drinking- as well as for meat and cheese consumption. 

“Now, there are many industrial appetites”, Valleriani tells me. “And they are backed by the local politics, which wants to reduce the area of the SIN”. To be fair, the area after Anagni is less contaminated than 20 years ago. The agricultural industry, another lobbying force in the area, asked for a redefinition of the SIN as well. “We are not opposed to this, in principle. But this should be done carefully”, Valleriani says. Anyway, Anagni will not be affected by this redefinition: the level of contamination is still one of the highest in the area. 

“Recently, another foam phenomenon was recorded in Sgurgola, around 10 kilometers away from the town, along the Sacco River. That’s because people dumped waste unpunished, especially from the industrial area in Anagni”, Valleriani tells me. “Nobody is accountable. You cannot check what’s the origin of the pollution, once it’s in the river”.

Installing a weapon factory in the area can potentially cause new contaminations in the soil. “To be fair, we’ve never recorded such contamination. But we can’t verify anything directly- factory access is restricted. And, if inspection permits arrive weeks later, it’s easy for everything to appear in order for an inspection”, Valleriani tells me. 

The nitroglycerin and nitrogelatin themselves, if not properly disposed of, can heavily contaminate the aquifers. In a situation where the water consumption is already limited, one can ask how all of this can get worse.

Palestine matters

Three weeks later, I come back to Anagni. This time, the committee organised a sit-in for Gaza in the center of town. I am in the Ousmane garden, a green area of more than three hectares, with an incredibly beautiful view of Anagni historical center and a valley at the bottom of it. It’s named after a volunteer who died because of a workplace accident.

I meet many different people, some of them were in front of the KNDS factory during my previous visit. There are readings of poetry from Palestinian authors. But the link between Gaza and Anagni is not just symbolic.

“We have good reasons to believe that KNDS exports weapons to Israel. We are considering this hypothesis, even if we haven’t yet found definitive proof,” Andrea Caporilli, an activist from the No War committee, tells me. “Officially, these are defense weapons. But it’s not hard at all to convert them to offensives. We think the ammunition is used by the oto-melara guns, which are part of the equipment of the Israeli navy”. 

There is also the Galix system, which KNDS exports also in Sudan, according to Amnesty International. The Sudanese war is one of the most violent conflicts in Africa, and to have information about what’s going on there is almost impossible.

“We know for sure that Leonardo [the Italian state-owned weapon enterprise], one of the main KNDS clients, exports weapons to Israel”, Ricchetti tells me. “So, to claim that we are exporting weapons to Israel it’s not impossible. This worries us: the wars are less and less between two armies. The main victims are civilians, attacked by states. We don’t want to be accomplices of war crimes happening in Gaza.”

The post Italy’s ‘Death Valley’: Resisting Europe’s Arms Drive, Toxic Legacies, and Gaza Complicity appeared first on Untold.

DNA testing kits, essential for identifying the charred and shattered remains of the dead, are blocked from entering Gaza. The result: a brutal ritual of guessing, burying in haste and uncertainty, and living with a grief that has no body to mourn.

On the dusty roads of western Gaza, mothers walk over mass graves, not knowing which patch of earth might hold the remains of their children.

“I step on their bodies every time I go there”

In Gaza, the dead are not merely mourned – they are ushered into the afterlife with a tenderness that binds generations. Funerals are communal acts of love, rituals of farewell that give form to mourning. Families gather to remember. The body is bathed, shrouded, prayed over. A funeral tent is erected. Visitors stream in with verses from the Koran and tears hidden behind quiet greetings. 

On the fortieth day, sweets are distributed in the name of the deceased – an offering for the soul’s journey. A year later, a memorial service – the sanawiyyeh – is held. Trees are often planted around the grave, living reminders of the lost. Sons are buried next to fathers. Daughters rest next to mothers. These are not luxuries. They are sacred threads in the fabric of Palestinian life. But all of this – every tender rite, every final embrace – has become impossible. 

Israeli bombs tear bodies apart. Names disappear with the flesh. Mass graves swallow them silently. And the DNA kits that might offer a last chance to say goodbye are banned. 

The cruelty is complete – not only are Gazans denied the right to live, they are denied the right to grieve.

As with all types of medicine, Israel prohibits the entry of essential medical supplies needed by Gaza hospitals. This blockade has resulted in the deaths of thousands of Palestinians and has prevented the families of the missing from identifying their loved ones due to the lack of DNA testing equipment used to identify bodies through bone or soft tissue analysis. 

The prohibition of any form of medication is a crime and a violation of international law in times of war. Although international organizations have attempted to confront this issue, they lack the tools to force the Israeli occupation to stop such actions.

Alternative methods of identification rely on clothing or previous scars on the deceased. 

Nasma al-Dahshan was nine years old. She was killed in front of her mother on al-Rashid Street during one of the family’s many displacements. Her mother, Samah, remembers the moment with a cold clarity that borders on paralysis.

Samah and her children set out to evacuate from Al-Shati refugee camp in Gaza to the southern part of the Strip, following instructions from the Israeli military. However, they were stopped during the evacuation and her daughter was killed. The mother, in her thirties, used to work as a seamstress, but the sewing machine she relied on was destroyed when her house was bombed.

“I saw her fall. The soldier pointed his gun at the man who was trying to help us bury her. We had to run. When the ceasefire came, I went back to the spot. She was gone. Her body disappeared like smoke,” Samah said, barely able to breathe.

“I kiss the ground where she fell. I feel like I’m walking over her body every time. I never got to bury her. I carry her grave with me wherever I go,” Samah exclaims.

The trauma has rewritten her internal architecture. She doesn’t dream. She avoids mirrors. She often stops in the middle of a sentence, suffocated by memories.

“What the occupation killed wasn’t just my daughter – it was my lungs. Now I breathe through grief. If there’s a cure, it’s in death. That’s the only silence I long for.”

These are not isolated moments of heartbreak – they are the everyday testimonies of a people living amidst ruins. According to mental health specialist in Gaza, Dr. Ismail Ahl, who has treated hundreds of such cases, the psychological toll of not being able to bury or even confirm the death of a loved one is “beyond ordinary grief.”

“In Gaza, we were already living with what we call pre-war trauma. But this war has shattered even the capacity to suffer. People are not just grieving. They are trapped in a kind of emotional paralysis because there is no closure,” Ahl explains. 

“I long for their hunger”

Mohammed Krayra, 46, lost his entire family in an Israeli raid on Al-Shifa Hospital, where they had sought refuge. He had gone out to look for food.

“They were starving. I went to bring them food. Now I am starving for them,” he says, sitting on the steps of a nearby clinic.

His voice cracks as he recalls being brought twenty bodies by overworked doctors, each burned beyond recognition.

“They asked me to identify them. I tried. But I couldn’t. They died twenty times before my eyes. I begged God to let me die with them,” he recalls.

 “I didn’t say goodbye. I don’t even remember their last faces. I dig my fingers into the dirt around the hospital – just to touch a memory, a trace, a scent. Anything.”

Krayra avoids people now. He twitches when suddenly spoken to. He hasn’t set foot in a home since.

A War on Memory and Identity

Ahl explains that the lack of DNA identification tools has turned grief into a psychological minefield.

“People can’t move on. Some have seizures, hallucinations, breakdowns. Children become withdrawn. Adults become shadows. Without knowing whether your loved one is dead, missing, or imprisoned, how do you live the next day?” Ahl says.

Sadiya al-Masri, 28, is one of many whose lives are suspended in this purgatory. Her husband disappeared in November after an airstrike leveled the building where he worked in al-Rimal. Rescuers pulled out body parts. None have been identified.

“Some say he was there. Some say he wasn’t. Some say the army took him. I don’t know if I’m a widow or a wife. His family wants his inheritance. I want his voice,” she says, her own voice shaking.

“I can’t sleep. I cry without knowing why. The DNA test could have told me if I should grieve or wait. I burn with a hope that could be a lie,” she adds.

Sadiya barely speaks now. Words weigh heavily on her tongue. She looks through people instead of at them.

Ahl notes that unresolved grief has led to social breakdown.

“Families are breaking up. Fights break out over inheritance. Children carry invisible wounds. Some stop eating. Some stop talking. The war is not just on buildings – it is on the mind, the soul, the family,” he adds.

No closure. No future

International aid agencies say they are overwhelmed. The backlog of unidentified bodies is enormous, and the lack of identification tools has turned morgues into archives of despair. Bodies accumulate and are being buried en masse, unnamed, unclaimed.

“Even if we want to help, we have to stop the war,” Ahl pleads. “We need to recover the stories of the dead so that the living can breathe again.

Until then, Gaza walks with the weight of its loss, in a war that won’t even let its victims rest in peace.

The post “I Carry Their Grave Wherever I Go”: Gaza’s Endless Grief and Unknown Bodies appeared first on Untold.

A video found on the phone of one of the paramedics found in the mass grave shows their last moments and was presented to the United Nations Security Council.

🚨This video was discovered on the cellphone of a paramedic who was found along with 14 other Palestinian rescue and medical workers in a mass grave in Gaza.

The Red Cross and Red Crescent Societies presented it to the UN Security Council this week. https://t.co/FozXtJ3Nsb

— Drop Site (@DropSiteNews) April 5, 2025

The incident highlights not only a pattern of violence against healthcare workers and hospitals but also the near-total absence of accountability for Israel’s conduct in Gaza, where the International Court of Justice (ICJ) has ruled that acts of genocide are plausible. These systematic attacks violate core principles of international humanitarian law and reflect an increasingly normalized assault on the right to health in war.

A global trend of escalating violence

In recent years, the targeting of healthcare workers, hospitals, and health infrastructure in conflict zones has escalated alarmingly, particularly in the West Asia and North Africa (WANA) region. Nowhere has this been more devastating than in Gaza, where the systematic destruction of the healthcare system by Israel has reached unprecedented levels. By early 2024, over 761 incidents of violence against Palestinian healthcare had been recorded — equivalent to the total number of attacks in Sudan, Ukraine, and the Democratic Republic of Congo combined.

The 2023 report by the Safeguarding Health in Conflict Coalition documented a 25 percent rise in assaults on healthcare facilities and personnel globally, making it the worst year on record. These included bombings, looting, and killings that paralyzed healthcare systems and left civilians without essential care. The report found that nearly half of these incidents were attributed to state forces. It identified clear patterns of violence against healthcare in places like Myanmar, Somalia, Sudan, Syria, Ukraine, and, critically, in Gaza.

“Conflicts where violence against healthcare becomes a consistent pattern frequently start with extreme levels of violence against the health system,” the report noted. In 2023, this trend was particularly stark in Manipur (India), Sudan, and Gaza.

Israel’s war on Gaza: Healthcare under siege

Israel’s bombardment and siege of Gaza have not only devastated homes and infrastructure but systematically dismantled its healthcare system. Hospitals and clinics have been bombed, medical convoys attacked, and healthcare workers abducted and killed. The Kamal Adwan Hospital, for example, was targeted in repeated airstrikes, and its director, Dr. Hussam Abu Safiya, remains in Israeli custody where he has reportedly been mistreated. Al Shifa hospital, Gaza’s largest medical complex, was also attacked and destroyed, with an investigation by Forensic Architecture revealing mass graves in the hospital grounds. 

By February 2024, the World Health Organization (WHO) reported that every hospital in Gaza was either damaged, destroyed, or rendered inoperable due to fuel shortages and attacks. The WHO had already documented 427 attacks on healthcare in Gaza and the West Bank by November 30, 2023, resulting in 566 deaths and 758 injuries.

Dozens of videos filmed by Israeli soldiers demolishing hospitals, schools and other civilian infrastructure have circulated online. One recent example is the destruction of the Turkish Friendship Hospital.

🚨Breaking: The Israeli army blows up and destroys the Turkish Friendship Hospital, the only hospital in Gaza dedicated to cancer patients. pic.twitter.com/QM0b3JKsDI

— Gaza Notifications (@gazanotice) March 21, 2025

In March 2025, a UN investigation concluded that Israel’s destruction of reproductive healthcare facilities in Gaza — targeting maternity wards, IVF clinics, and restricting access to essential care — amounted to genocidal acts. The report detailed how these deliberate attacks, along with restrictions on food and medical supplies, have partly destroyed the reproductive capacity of Palestinians in Gaza. 

“They ordered all of us, men and women, to take off our clothes and to continue walking, ordering us to only look forward. I was walking naked between the tanks, not even wearing underwear. An Israeli soldier spit in my face. I forced myself not to react as I knew they would… pic.twitter.com/8hW3C901tj

— Jewish Voice for Peace (@jvplive) March 21, 2025

Israeli attacks on healthcare in Lebanon

Israel’s attacks on healthcare have extended beyond Palestine’s borders. During its attacks on Lebanon, from October 2023 to October 2024, Israel bombed 37 health facilities and killed 70 health professionals. By November 1, 2024, the toll had risen to 178 healthcare workers killed and 292 injured. A total of 243 ambulances, 84 clinics, and 40 hospitals were affected by Israeli attacks.

The WHO has noted that nearly half of the healthcare attacks in Lebanon resulted in fatal outcomes, making it the most deadly conflict for health workers globally in terms of mortality rate per incident.

The sheer scale of these attacks has prompted international legal responses. In December 2023, South Africa filed a case at the ICJ accusing Israel of genocide in Gaza. Numerous countries from the global majority have joined the suit. In 2024, the International Criminal Court (ICC) issued arrest warrants for Israeli Prime Minister Benjamin Netanyahu and Defense Minister Yoav Gallant for war crimes and crimes against humanity.

Despite these moves, Israel has faced no sanctions or meaningful accountability from its Western allies. This impunity stands in stark contrast to the legal obligations of states under international humanitarian law and the Genocide Convention.

A broader pattern: Attacks on healthcare in Sudan, Syria, and Yemen

In Sudan, the ongoing conflict has led to significant damage to healthcare infrastructure. In the first 500 days of the civil war, nearly half of the hospitals in Khartoum were damaged, severely impacting medical care. A report documented damage to 41 of the 87 hospitals in Khartoum, violating international humanitarian law and pushing the already fragile health system to the brink of collapse, with 70 percent of health facilities inoperable in affected states.

​An UntoldMag investigation revealed systematic attacks on hospitals in Al Fasher, targeting medical professionals and further decimating Sudan’s healthcare infrastructure.

Sudan has since lodged a case at the ICJ against the United Arab Emirates (UAE), accusing it of breaching the genocide convention by funding and arming the Rapid Support Forces (RSF) rebel group in Sudan’s ongoing war. Sudan alleges the UAE supported the RSF in committing genocide, murder, rape, and other human rights violations.

In Syria, the decade-long war has also witnessed extensive targeting of healthcare facilities and personnel, leaving the country with a battered and overwhelmed health system. In 2021, a report by the International Rescue Committee showed some of the devastating losses and attacks on healthcare in the country. Of the people surveyed in the report, 56 percent said they would be afraid to live near health facilities because they are targets.

In Yemen, the protracted conflict has led to numerous attacks on healthcare facilities by the Saudi-led coalition, further deteriorating the already fragile health system. The destruction of hospitals and clinics has left millions without access to essential medical services, exacerbating the humanitarian crisis. Reports indicate Saudi Arabia and the UAE have conducted over 130 attacks on hospitals and healthcare infrastructure, violating international humanitarian law. 

The collapse of a legal and moral order

This increasing normalization of attacks on healthcare facilities and personnel reflects a crisis in the post-WWII world order, with international law, institutions, and protections under an unprecedented attack. 

Protections enshrined in international law — particularly the Geneva Conventions — are routinely flouted, especially by powerful states and their allies. While legal mechanisms like the ICJ and ICC offer glimmers of hope, they remain toothless without enforcement mechanisms and political will.

The ICC and ICJ cases, along with reactions from Western countries, highlight the lack of accountability for perpetrators. Without sanctions, legal action, and the end of political shielding for countries like Israel, the erosion of norms protecting civilians in conflict will continue — and with it, the further collapse of the fragile systems meant to protect life in times of war.

An emotional speech by pediatric intensive care doctor Tanya Haj-Hassan, who has worked in Gaza, reflects the dangers of normalizing attacks on hospitals and medical workers.

18 months of this holocaust. Our leaders still support it.

“When I was in Gaza, I felt like it was the prelude to the end of humanity,” heroic doctor Tanya Hassan told UN.

Don’t you feel it, too? I cannot see a way back from what we’ve allowed to happen.pic.twitter.com/bf0YvDzF8c

— Matt Kennard (@kennardmatt) March 20, 2025

The normalization of attacks on healthcare is a direct consequence of this impunity. It reflects not only a collapse in global governance but a dangerous redefinition of what is permissible in war. As long as perpetrators face no consequences, hospitals will continue to be bombed, doctors will be treated as combatants, and the right to health will remain one of war’s earliest casualties.

The post Across War Zones, Targeting Healthcare has Become a Strategy, not an Accident appeared first on Untold.

This story is about how local medical teams served civilians during the first months of the siege. Most names have been replaced with pseudonyms for the safety of survivors.

I.

When Reem, a Sudanese woman in the besieged North Darfur capital of El Fasher, arrived at the Saudi Specialized Hospital for Obstetrics & Gynecology, the last maternity hospital left here during Sudan’s year-long civil war, she required an emergency cesarean section. It was 19 May 2024, just weeks into the Rapid Support Forces (RSF) siege of the city

Like clockwork, the maternity team registered her, discovered her pregnancy was blocked, likely due to previous scarring, and moved her to the operating theater. That’s when the physicians of Unit #4, known as the “Butterfly Unit,” took over. 

Dr. Samar, along with a team of nurses, an anesthesiologist, and others, performed the surgery. Samar’s team made the incision, delivered the baby and placenta, closed the wound, and the mother now had Darfur’s newest child.

But just after Dr. Samar’s team moved Reem and her newborn from the operating theater to the recovery room, there was an enormous explosion, blasting the windows out across the surgical theater and nearby rooms.

“That was the most terrible position I ever faced in my life,” Samar remembers, bracing herself. Her fellow “Butterfly Unit” doctor, Dr. Aisha Hassan, was just in the next doorway. 

“The force of the explosion broke every window around the area where people were conducting surgery,” Aisha recalls. “It was like being hit by lightning. Every person at the hospital was in shock. I just stood there in place. I didn’t even run or anything. The explosion injured eight people. We had to perform first aid and then transfer them to the South Hospital.”

Dr. Hassan Osman, the Saudi maternity hospital’s young, bespectacled medical director, who had known Samar and Aisha since school, quickly assessed what had happened. Everyone knew that the Sudanese government, which had spent two decades building its Rapid Support Forces (RSF) largely with Arab Baggara tribal militias from around Darfur, now faced those same forces who had turned against them countrywide. 

By May 2024, the RSF had taken most of Darfur, surrounding the city of El Fasher. Over the next six months of fighting, Sudan Armed Forces (SAF) and the Joint Forces (JF) supporting them in a temporary alliance dug in and held their positions but could do little to stop the RSF from firing on civilian positions.

Until this direct hit on the maternity hospital, the medical teams of El Fasher had remained optimistic, hoping and praying that no fighters would ever target a health center. Hassan informed allies of what had just happened, sending images of the broken water tank, generator, and shattered glass.

“I’m very sad to tell you that a bomb hit the maternity hospital today,” he wrote to this writer, “a rocket shell. There were nine injuries, three of them serious—passersby and merchants outside the hospital. Please, if you can, let the world know.”

In the coming months, Sudan’s year-long civil war would lead to six months of violent siege for El Fasher. Fighters would bombard the maternity hospital at least 16 separate times, alongside attacks on nearly every hospital and health center across town. The war was escalating, and in this war, hospitals were no longer safe.

Very quickly, Hassan’s team of obstetric and gynecology specialists would be forced to transform this modest maternity hospital into the region’s last emergency war hospital.

In the fighting to come, El Fasher’s one million residents would be cut off from their water supply, food convoys, and even aid, creating famine conditions as the government and RSF fought for control. 

As international aid agencies largely withdrew and ran out of funding, local Sudanese medical teams would be forced to save lives under fire with shrinking supplies. Some would be killed, many wounded, many evacuated, and still others would have to keep this war hospital running under some of the toughest conditions in history.

II.

When we started this story, we wanted to understand how Sudanese medical teams save lives on the frontlines and what the international community could do to provide them with more support, especially in light of the dramatic global rise in attacks on health workers as reported by Insecurity Insight alongside the Safeguarding Health in Conflict Coalition. 

But we had not anticipated how quickly most of the international community would withdraw, leaving local Sudanese doctors very little support as they provide healthcare under harrowing conditions. Opportunities to arrange air drops of supplies or transfers of funding for local purchases have been largely held up by donor fatigue and bureaucracy at a violent time.

While interviewing Hassan, his team of doctors of Saudi maternity hospital’s Unit #4, as well as other surgeons, trauma medics, aid workers, and survivors remotely from Berlin, Germany, this writer worked with photographer Mohamed Zakaria, referred to here as Mo, reporting on the ground. Early in the siege, Mo produced visual documentation of the war in his native El Fasher for the BBC, which agreed for him to provide photos for this story and assist with additional reporting.

Mo, a tall, confident visual artist with a serious demeanor alongside a warm sense of humor, had grown up in El Fasher. He met Hassan in the same circles where Samar and Aisha spent time, and then met another media colleague, Mohamed Faisal, known as Keeta.

Together Hassan, Mo, and Keeta would propose making films together about life in Sudan. They wanted to show how the western region of Darfur was recovering from the troubles of past decades, how technology, the arts, and diversity were coming to their rapidly growing city.

That led to the creation of their production company, Dar Productions, which would host media teams to cover health services in the region. But they never imagined this collaboration would lead them to be among the last in El Fasher to tell the world what was happening when war broke out.

Over the past years, media companies ranging from CNN to Al Jazeera had come to El Fasher to capture video and photos—not always of the city’s thriving market and green oasis barbeques, but more often of the massive displaced family settlements on the scorched edges of town, or the clinics and field hospitals in Zamzam, telling the world about desertification and its impact on displaced survivors of the earlier war and hunger. Mo would grab his camera and gimbal, Keeta would arrange the clients, and Hassan would help the media connect with hospital or aid agency staff for interviews.

But when the war broke out and the siege drew closer, Hassan shifted all his focus to the medical response, serving as medical director at the Saudi hospital with general manager Hami, their staff, and an increasing number of volunteers who wanted to help—many of whom had lost their homes and sought shelter nearby, eager to contribute. Meanwhile, Keeta went abroad with his family, and Mo decided to apply his skills as a war photographer and stayed with his camera ready even as the war surrounded them.

On 11 May, just as Hassan, Mo, and I agreed by phone to produce a story series on El Fasher’s local medical teams, fighters bombed the Babiker Nahar Pediatric Hospital, killing one staff member and two children, and knocking the hospital out of service. 

The following week, fighters also hit the Saudi maternity hospital and fully encircled the city. In one of our first talks about the war they were witnessing on the ground, Mo told me there were dead bodies in the street. Shortly after, he sent a video of the smoke plume from a mortar or rocket that had detonated not far from where he had taken cover.

III.

​​Long before Sudan’s civil war erupted in April 2023, Darfur had endured waves of ethnic violence. El Fasher, the capital of North Darfur, however, had long been seen as a bastion of hope and one of the safer, multicultural communities. Families escaping ethnic violence across the region, if they didn’t escape across the border, would come here. 

The Sudan Ministry of Health (MoH), led regionally by Director General Dr. Abdullay Omar and South Hospital’s medical director and top surgeon, Dr. Awad Abbas, faced difficult choices in this fragile environment.

MoH teams aimed to provide healthcare impartially, treating civilians and military personnel alike, regardless of ethnicity or religion. However, as the international community condemned the Sudanese government, the Rapid Support Forces (RSF), and the overlapping janjawid militias (devils on horseback) for their roles in ethnic violence, including during the 2003-2008 Darfur War and 2013 Darfur clashes, ensuring equal healthcare for all became increasingly difficult. Some international donors even boycotted health centers linked to the government.

Medical teams, including those led by Dr. Awad Abbas, the medical director at South Hospital, the main medical center, and Dr. Hassan, medical director at Saudi Maternity, faced a dilemma, whether to serve the city’s urban elite or join humanitarian clinics supporting thousands of displaced families in surrounding areas like Zamzam and Abu Shouk. 

International aid agencies and local health workers had set up field hospitals and women’s clinics on the outskirts, while South Hospital, with help from organizations like Doctors Without Borders (MSF) and Relief International (RI), became a hub for specialized care. Soon, the “Butterfly” women’s health teams began rotating through these hospitals as staff was limited and the medical community agreed together to cross-train staff to be sure they could cover each other’s roles when needed as the war approached.

Within this context, the Saudi maternity hospital team stood out. Led by Hassan and his general manager Hami, this highly organized team—composed largely of women—treated pregnancy complications such as eclampsia, hypertension, and hemorrhaging, as well as gynecological issues ranging from fistula infections to wounds from rape and sexually transmitted diseases. 

Before the war, Saudi Maternity was seen by many as a feminist team in a conservative society, which put many medical staff in the awkward position of representing Islamic, traditional, and family values while at the same time offering women and girls advice, when asked, about how to cope with rape, domestic violence, early pregnancy, or being disowned because of a feminine health struggle. This was where girls who had been raped or had humiliating infections went quietly, sometimes unable to return to their families.

Despite the stigma, the maternity staff, including Unit #4 pushed through chauvinism to focus on the beauty of nafeer—the tradition of working together for a common cause—and helping women of any background survive childbirth and witness their newborns’ first breaths.

When one entered the wide orange and pink stone halls of Saudi hospital, one found Hassan there, his contagious smile reminding everyone of unity and commitment. He would stay at his station or desk as long as necessary to keep the place running smoothly, even when the Starlink satellite internet faded, the generator or solar power waned, or he hadn’t eaten since morning.

Working alongside Hassan, there was Dr. Samar, the quiet one, who had known Hassan since secondary school and was there the day the first bomb hit their hospital. There was Dr. Aisha Hassan, an only child whose mother had pressured her to become a doctor, but who had grown to love it. She met Samar and Hassan at university.

There was Dr. Eilaf Mohamed, the one with the huge smile who liked to crack jokes to keep everyone’s spirits up. And there was Dr. Afrah Hussein, among many others. Afrah was the sweet one, full of emotion. 

Who wouldn’t react full of emotion after seeing mothers cross the desert to reach the hospital with complications, witnessing their children survive, and then fearing rockets could crash through the windows at any moment?

“During the war,” Dr. Eilaf recalls, “the maternity hospital team was the most unified of all. They did their work with love. Everyone there was there because they wanted to give back to society, to help women—not because it was just their job or because they had to.”

“Kind and helpful colleagues,” Dr. Afrah remembers. “The beautiful ‘Butterfly Unit’, Unit #4. We called our unit the ‘Butterfly Unit’ because we were all women—house officers, medical officers, and registrars. We worked with love, and the hospital became our safe haven, our warm home where we worked, learned, and had fun. We formed a family.”

Both then and now, as their journeys have taken them in very different directions, the Butterflies remain united as friends—among the rare few who literally had to deliver babies during artillery barrages.

“We had the best team at the maternity hospital,” Aisha told me during a call. “The work environment was dynamic and allowed us to be close. Every team knew what to do. For example, we had a patient with a ruptured placenta. It had separated from the uterus—an ectopic pregnancy. She was hemorrhaging and had lost so much blood, so we arranged for surgery.

“Then she had postpartum bleeding and lost more blood, going into shock. We gave her life-saving drugs. Some prepared blood. Thanks to our teamwork, she survived and was doing well. When you have a good working environment, you can accomplish anything.”

IV.

A few weeks before the surgical theater blast, Aisha, Samar, and Eilaf met during a break in the courtyard area. Eilaf made a call to check on friends, then checked on a new mother with her infant, and returned to take a seat outside.

“That’s when I heard the sound of the bullet coming through the ceiling,” Eilaf remembers. “I tried to move, but it happened in the blink of an eye, in the spark of a second… I had believed the war would never come near a hospital, that soldiers would never treat a hospital as a target.”

“Suddenly, a stray bullet flew in and hit her ankle,” Aisha told me. “It was a very hard moment for us. It could have hit her anywhere—her head or her chest. She was very brave to endure that pain and remain patient about what happened. We provided first aid and then transferred her to the South Hospital, which was the main hospital at the time. We were in shock.”

By that time in mid-April, the RSF had already taken most of Darfur and surrounded the city of El Fasher, as well as the nearby mountain enclave of Jebel Marra. 

On 10 May, the RSF officially closed the siege line, blocking the roads and water sources, then attempting to penetrate the SAF lines through the displacement settlement on the north side of the Abu Shouk neighborhood. 

The next day, fighters—though it is still disputed who fired this early round—hit the Babiker Nahar Pediatric Hospital, killing one staff member and two children, and forcing the hospital to close. At the time, Dr. Abubakr Abdulla, another colleague from the medical circle, contacted Mo and then told me what had happened over the phone.

“After the fighting started, the pediatric hospital was too deep in the war zone,” Dr. Abubakr told us. “The first bomb hit the yard in front of the hospital. Everything there collapsed inside. Even the doors were bent inward. There were many injuries and one immediate death (the others died later). 

“I was in the operating room when the bomb hit the hospital floor,” Abubakr continued, “and we had a difficult time. Everyone panicked, so we built a wall from the inside just to protect ourselves. The war zone was too close to the hospital. Then the hospital manager decided to evacuate.”

As the siege intensified, Hassan would call me and other allies and media to update us on the worsening situation. On 13 May, Hassan was again in shock.

“The situation is very bad. Three days of fighting, many victims and injuries. Many people were shot in my hospital—I think by a sniper or misfire. And many bombs have fallen nearby. We are still working. Unfortunately, three or four bombs fell in front of the house where my family had relocated. Fortunately, no one was injured. Also, yesterday while I was driving near South Hospital, a sniper tried to shoot my car!”

“Imagine working under the sound of bullets,” Afrah later reflected on this time, “with the hopes of many people pinned on you—sometimes succeeding, and at other times failing to save them. Those were sad days, filled with the smell of death and sorrow…”

Increasingly, as Sudan’s economy was already strained by extreme disparity, desertification led to worsening droughts, punctuated by shock floods that destroyed houses and brought malaria. Then, the war filled with undisciplined soldiers, and the Butterflies’ patient outcomes didn’t always go as well. 

Eilaf recalls numerous women with fistula whose families turned against them due to the stigma. Aisha remembers rape survivors who had to sneak in to ask questions they could never pose to their families.

In a harrowing example of how war worsens health outcomes, one young woman, whom Eilaf remembers well, arrived just as the war drew near. She had gotten pregnant by accident and, fearing family judgment, attempted to end the pregnancy herself. 

Tragically, she broke the stick she had used. The maternity teams rotated, some conducting investigations, finding the particles, attempting to remove them, and offering her dialysis. But by then, the war was so close that supplies had run out, power was failing, and there were too many wounded to tend to all the resident patients. 

Amid the chaos, the young woman died. The Butterflies, keeping each other positive, carry these painful memories as they strive to move forward.

On the other side of town, not far away, Eilaf was recovering from the bullet wound in her foot.

“Actually, nowhere is safe now in El Fasher,” Eilaf told me over the phone. “Even the hospital is not safe. I don’t know if Hassan told you. It feels like inevitable death here because there is no way to escape it. I just feel like someone is going to die, that I’m going to die in the next second, the next…”

Her voice was then interrupted by four very loud close booms I could hear over the line.

“I don’t know if you can hear this or not, but it’s terrifying.”

V.

Dr. Awad Abbas, the dedicated surgeon from Khartoum who quickly rose to become the beloved medical director at South Hospital—the main hospital for emergency trauma cases, orthopedic fracture care, and primary care—was under immense pressure.

“During one day,” Dr. Awad told me about the beginning of the siege, “we received about 150 injured patients. In the same surgical unit, we performed general, orthopedic, and pediatric surgery in one theater, which contained two rooms. We did it harmoniously. We treated all patients without discrimination.”

Awad coordinated with Ministry of Health Director General Dr. Abdullay on one hand, his best surgeons, Dr. Fowzi and Dr. Mustafa, on the other, and also with the heads of the other surviving health centers, including Hassan at maternity, Dr. Osman at Al Shuhada, Dr. Wafa at Abu Shouk, and others.

Doctors Without Borders (MSF), for their part, had helped to build and advance South Hospital’s core emergency services and skills training while also expanding their field hospital in Zamzam and maintaining clinics on the RSF-controlled side of the line.

Christos Christou, the MSF international president, regularly appeared in the news and on social media, visibly exhausted, calling for an end to attacks on hospitals and health workers not only across Sudan but also in Palestine and many other countries. 

Relief International (RI) also had to evacuate expatriates and shift resources, but continued to help with ambulance services and supplies and remains one of the few international organizations working on both sides of the siege line. RI Country Director Kashif Shafique was eager to get into Sudan, but security was so bad that he had to aim first for Port Sudan, while his local team managed with limited resources.

Mohamed Abdi, the Country Director for the Darfur Peace & Development Organization, whom I had met through DPDO founder Suliman Giddo, had introduced me to Hassan early on, as his team attempted to provide health assistance to a field clinic outside Abu Shouk and clean water to the maternity hospital, now had to brace as fighters bombed their flagship, the Subsaharan University College, eventually destroying it completely.

While writing this story, I reached out to a women’s health specialist at the International Rescue Committee (IRC), which had shifted its efforts toward other regions. The specialist was bringing the case of El Fasher’s women’s health  to the Inter-Agency Standing Committee on sexual and reproductive health. 

After a week of deliberating Sudan alongside Palestine, Myanmar, and so many other emergencies, they told her the best they could do was add a paragraph about it in their newsletter. Sudan women’s health, especially in Darfur, which was once the headline of human rights rallies and causes all over the world during the long failed “Save Darfur” movement was now out-prioritized by so many other women’s health emergencies around the world, the embattled Saudi maternity hospital, bombarded and starved, was now considered too far down the list. 

When I contacted Christine Wille, director of Insecurity Insight (II), one of the leading organizations tracking threats to health works worldwide, advocating alongside the  Safeguarding Health in Conflict Coalition (SHCC). She assured me that her coalition and organization were deeply concerned, yet none in their alliance had the power to act during the violence, only long before, or after the smoke had settled. 

“The international community should approach these attacks on healthcare,” Ms. Wille said, “through prevention, response, and lessons learned. There is a need to support attacked health facilities in the aftermath by providing as much emergency response as possible. However, the possibilities are somewhat limited if the appropriate structures were not in place. It is particularly important that the international community does not simply move on, but takes stock of what happened, why, and how the consequences could have been prevented.”

However strong the SHCC, II, and related WHO offices advocated on health worker safety in the longer run, there remained no clear UN or INGO or safety office which could just get on the phone to advise Dr. Awad, and others on how to better prepare bomb shelters, reinforce walls, or train staff on safety in these situations while the bombs were hitting. 

While all this was happening, the Butterflies and other medical units rotated between health centers in El Fasher on 24-hour shifts. Among them was a young medical volunteer named Sajida Abdullah Al Mouli. On 23 May, Sajida headed to support the Emergency Response Rooms at a clinic on the edge of Abu Shouk when fighters attacked, and she was killed by a stray bullet.

After this, the Butterflies and many other medical staff faced the toughest decisions of their lives: whether to stay and serve their community or escape and take their families to safety. 

Eilaf, who had already been wounded, grabbed her mother and sister, who were initially reluctant, and slipped out before the RSF fully closed the roads. Eilaf made her way to South Sudan and then onward to Uganda, while Aisha followed suit.

Meanwhile, Afrah escaped west past Tawila to the Chad border, and Samar left for another region. Among the Butterflies who stayed at the Saudi hospital working with Hassan was another close friend named Dara. She made a commitment to herself to stay as long as she could. Now the Butterflies were spreading out between at least five countries, those outside calling for support when possible to those who stayed behind.

In the coming days, even Mo, who was filing stories for the BBC and saving images of the health teams for our story series, helped a wounded neighbor, only for their car to be hit by an explosive, wounding him, as well.

“These days are so difficult—the shelling is everywhere,” he wrote to me as he weighed his options: whether to stay when he could barely cross the neighborhood safely or to escape with friends. “See you tomorrow, inshallah.”

VI.

On 8 June, Dr. Awad and Dr. Abdullayh were overseeing the evacuation of South Hospital. Fighting had already come too close, international agencies and governments were unable to help, so they chose to begin moving patients to different parts of the city. 

They evacuated many stable patients to the Al Shuhada health center, while the war hospital responsibilities would have to be absorbed by Hassan’s team at the Saudi maternity hospital. However unprepared they were, there was no other way. MSF and RI were closeby but spread too thin to do much more than advise and offer dwindling supplies.

“Every day, the war came nearer to us,” Dr. Awad recalls. “We knew this because bullets penetrated the walls of the operating theater, the outpatient clinic, and so on. One day, while we were operating on a patient, a bullet penetrated the walls, and many fragments fell on the patient while we were working on him.”

“On 8 June, Dr. Abdullay from the Ministry of Health and I came to the Saudi Hospital to prepare the backup theater room. When we returned to South Hospital, we found intense, massive shooting—bullets everywhere. 

“We didn’t know the RSF would come so close to the hospital like that,” Dr. Awad told me. “Suddenly, as we stepped out of the office, we heard women shouting and crying. Dr. Abdullay and I moved forward to see why they were crying. Suddenly, we found RSF military in front of us, and they asked Abdullay, ‘Are you civilians?’”

Awad explains how the destruction alerted not only the few doctors and staff helping with evacuations but also bedridden patients, post-op patients, and those with disabilities. Some were climbing out of beds, while others pulled wheeled beds to bring their sick or wounded neighbors to safety. 

Dr. Fowzi, one of the more well-known surgeons, rumored to have been beaten, escaped, but according to Awad, was badly injured while jumping over the outer wall. It took him weeks to recover. 

RSF fighters beat and threatened Awad and Abdullay, according to Awad, and left them for dead. Somehow, they managed to get back up, lurch back to the Saudi maternity hospital, and, after some time to recover from the trauma, resumed providing services. 

Amid all this drama, Relief International team member Musa Adam Suliman had, just a few days earlier, driven to the Zamzam displacement settlement and brought back a pregnant woman with complications. But as he was driving toward the Saudi maternity hospital, a fighter shot him through the vehicle window, hitting him in the chest. 

Witnesses eventually brought him to South Hospital to wait for surgery that could have saved him. However, the attack on the hospital that night complicated his situation, leading to his passing. Kashif, a deeply caring director, not only released the usual mourning news statement but also appeared in video interviews, visibly exhausted and devastated.

El Fasher’s violent situation had become so complicated that the international media made an incredibly bizarre and unfortunate decision. 

While Mohamed Zakaria, now escaping overland through South Sudan, and I had been keeping up with multiple hospitals—South Hospital, Saudi Hospital, the university teaching hospital, Al Shuhada, Al Iqrah, Zamzam field hospital, and the military hospital–and with Dr. Awad’s evacuation of patients to consolidate trauma services, orthopedics, and pediatrics alongside maternity at the Saudi hospital—many other journalists only focused on MSF press releases. They told the international community, falsely, that there were no more hospitals left. 

The MSF team issued another press release about the 10 June attack on South Hospital. Their coverage, thanks to their local team, had been strong, yet in the rush, they announced that when South Hospital was forced to close due to the attack, there were no other hospitals left with the highest quality equipment and operating theaters. Their clarity was truncated.

Everyone in El Fasher, and most internationals following the situation closely, knew that the Saudi hospital and its Butterflies were now absorbing South Hospital’s evacuated intensive care and surgical patients.

However, major outlets like the BBC , The New Humanitarian, and others misunderstood the MSF release, claiming there were no more hospitals left. 

According to our interviews and research, there are indications this may have led UN and INGO decision-makers in Geneva and New York to then triage El Fasher healthcare, assuming the city was lost

“South Hospital was one of only two with surgical capacity,” MSF told us with nuance that larger newsrooms seemed to have misinterpreted. “It was the main referral hospital for treating war-wounded in El Fasher and the only one equipped to manage mass casualties.” 

Up to that point, MSF reported that “over 1,300 casualties sought treatment there.” In following press releases, they clarified that, indeed, the long ignored Saudi hospital was now the most important facility absorbing the war wounded. 

While most other agencies shifted efforts toward the border or to the Tawila transit points, MSF, RI, DPDO, and ALIMA remained, and Save the Children  still funneled some assistance to local partners. Local medical teams felt the dramatic reduction in effort.

Dr. Awad finally called me in mid-August to offer an exclusive interview about what had happened and what their urgent needs were city-wide, as other press and aid agencies had stopped asking him for interviews since then. Not only the international aid agencies but also the media and advocates had abandoned them, he felt. 

VII.

Humanitarian aid agencies and donors worldwide have often overcome war sieges to provide assistance. Since the 1967-1970 Biafra War in Nigeria; the 1992-1995 Bosnian War sieges of  Sarajevo, Dobrinja, Gorazde, Srebrenica, and Zepa; the 2007-2012 encirclement of Mogadishu, Kismayo, and Baidoba in Somalia, and other cases, the UN has coordinated aid by first negotiating access for humanitarian convoys. 

When blocked by fighters, flooded roads, or destroyed bridges, they arranged air drops of supplies. More recently, in places like Ethiopia and Nigeria, teams delivered medical supplies by drone carriers, even where “white hat” drones crossed air space patrolled by “black hat” drones used by armed groups. Additionally, cash transfers have often worked, allowing trapped teams to use electronic credit or cash to buy local supplies.

In Sudan, the war has been brutal, and many international governments and donors are cautious to let their support help either side, and yet the local Emergency Response Rooms (ERR)—networks of Sudanese civil society workers aiming to help communities while remaining impartial on political matters—have done wonders with mobile cash transfers. 

In El Fasher, medical directors like Awad and Hassan have pleaded for mobile app cash transfers to buy local supplies. Even where warehouse stores were depleted or burned, local escapees would sometimes sneak back in with medicines bought at clinics and pharmacies in neighboring countries. However, donors have been highly reluctant to support this in Sudan, even as scores of people die from preventable illnesses, malnutrition-related conditions, or wounds that would otherwise not be fatal.

During separate phone calls with Awad and Hassan, I asked them what was still possible. Both argued that while the Geneva talks stalled over allowing humanitarian and food convoys in, and although the border has been opened, there are still flooded roads. 

Despite this, there are opportunities to save lives by sending medical supplies from Port Sudan via SAF air drops and conducting mobile app cash transfers, which can be closely monitored for accountability.

In this context, Hassan and I discussed over the phone how a larger agency or new donor could potentially arrange, through DPDO or Relief International, an air drop of medical supplies, if not cash transfers. 

Saif at DPDO had figured out a method and had a connection. They just needed a donor with enough resources to cover the costs of such an operation, which could save countless lives. Few donors have been willing to step up, and only a few have followed through with other agencies focusing on field clinics so far.

On 24 June, right after Hassan and I discussed this possibility, fighters fired rockets directly into the Saudi hospital’s pharmacy building, destroying vast quantities of medication and fatally wounding the pharmacist, another of the young women doctors who had graced the halls of Saudi. 

Dr. Amna Ahmed, whom many knew through the rotations or from discussing how to trust alternative medications would be safe for patients, had worked not only at the Saudi hospital but also with Awad at South Hospital. 

With Sajida, Musa, and now Amna gone, and many others wounded, El Fasher’s medical teams—shrinking as most fled—became a smaller but more unified force, determined to survive.

VIII.

By July, as Eilaf, Aisha, and Mo made it to Uganda, Afrah to Chad, and Abubakr to Oman, the Saudi Hospital—now combining the emergency, surgical, pediatric, and maternity teams under one roof, with Awad, Hassan, and others working together, and Dr. Dara among the remaining Butterflies—was being targeted so intensely that they finally resorted to digging a new bomb shelter and trenches in the same space where women had long came to deliver babies. 

Then after a brutally long drought season, the shock rains came. Beyond the new shelter taking in water, this also meant that the wounded and malnourished patients would now be joined by those suffering from malaria.

MSF at last clarified its earlier statement, and the international press corrected its reporting on the siege of El Fasher, acknowledging that the Saudi maternity team was still operating and in urgent need of assistance:

“As a result of these incidents, the Saudi hospital,” MSF announced, “which was previously a specialist maternity hospital—has become the only health facility in the city with surgical capacity and the ability to treat the wounded. Now, its ability to keep its doors open is also in jeopardy. We urgently need to bring in more supplies and more personnel to respond to this crisis, but the fighting is preventing us from being able to enter…”

In Uganda, the Butterflies look back, hoping to advocate for support for their colleagues still working in El Fasher.

“For my country, Sudan,” Dr. Eilaf says, “I think we face a very dark future because clashes are spreading to areas that were once safe. I hope they will find a way to end this violence, at least to stop these clashes for a while. Inside that terrible war, there are superheroes like my friends risking everything to save lives, but it’s not easy. We can never forget them…”

“No more conflict, running, or searches,” adds Aisha, who now stays nearby. “But to work, we have to start over and get licensed as physicians all over again. Somehow, the Sudan government must provide us with documents. Otherwise, we cannot practice medicine here. But I will try every way to start over again.”

Through the first weeks of August, Hassan wrote to let me know they were being attacked again. Now and then, he and the others had been able to step out for coffee across the road or go to the mosque, but even the mosque and café had been hit recently. During one lull, staff members celebrated a wedding, complete with whatever food they could bring together, dressing up, and sharing imagery of the event online. 

Nevertheless, the bombing came back again and again. Ultimately, they had to stop admitting patients, only allowing rapid in-and-out care. They had to tell people it was more dangerous to stay in the hospital than to go home. 

As of 11 August, MSF reported the latest casualty numbers—likely undercounting, as many died in their homes or on the way to seek care—at 2,500 total casualties treated and 370 deaths in El Fasher’s hospitals. Many more died without reaching medical care.

Now in September 2024, with humanitarian convoys on the edge of Darfurand few donors willing to support air drops or cash transfers, RSF forces have penetrated the city deeper than ever before. With the combined war hospital team overwhelmed but continuing their work, Dr. Awad leaves us with a desperate message that their story is not yet over. They keep going.

“Even if I die,” Dr. Awad said. “I will not stop providing services to my community. I want to save my people as much as I can. For the organizations, if they would like to help the community, they should reflect on what has been happening and share in their suffering. They should stop those who are preventing people from accessing healthcare and medicine. International organizations should not leave these people behind. These are human beings.”

*Reem is a pseudonym for the patient who remains anonymous. Dr. Samar is a pseudonym for one of the doctors we interviewed and are still in touch with who evacuated but is still inside Sudan.

**This story has been supported by the International Center for Journalists as part of a series on health innovation.

The post Time Running Out For Medical Teams in Sudan: Inside El Fasher’s Last War Hospital appeared first on Untold.